Steven and Kathleen Brewer were separated for six months before they moved into a Moorhead home under the care of Peter Otoo, an adult foster care provider.

Married for 7½ years, the Brewers lived together before Steven, 54, got sick this summer. He spent time in the hospital and a group home, was unable to walk and had to use a wheelchair.

The Brewers wanted to live together again but knew they needed assistance. They found adult foster care, where caregivers provide services to clients in a home environment, through Lutheran Social Services of Minnesota’s Host Homes program.

There are 32 Clay County individuals like the Brewers placed in family adult foster care where clients live in a home with their primary caregiver.

Adult foster care programs in Clay County could grow as the state continues to push for more integrated living for adults with disabilities. Home-based care is also the goal of a grant program in North Dakota, and a new Veterans Affairs program in Fargo is looking to place veterans in foster homes.

A win-win affair

For the past 25 to 30 years, Minnesota has moved away from institutional services in favor of community-based care for people of all ages – from those with disabilities to aging seniors, said Loren Colman, the Minnesota Department of Human Services’ assistant commissioner for continuing care.

Colman said Minnesota values adult foster care because it promotes community integration for people with disabilities.

“It also is a less-expensive way to support people who need public dollar support, so that’s attractive to us in terms of being able to serve more people with the public dollars available,” he said.

Minnesota spending on home and community based care was almost triple what it spent on institutionalized settings in state fiscal year 2012.

North Dakota’s Department of Human Services also aims for community integration through a grant program that helps people transition from institutions to a home setting.

Karen Tescher, assistant director of the long-term care continuum and medical services for the North Dakota Department of Human Services, said the state’s “Money Follows the Person” grant provides funds for people who have been in a nursing home or intermediate care facility to return to community-based services, including living independently or in adult foster care.

The state was awarded $8.9 million for the program in 2007 by the federal Centers for Medicare and Medicaid Services.

Since 2008, 172 people throughout the state have moved to home settings through the program, Tescher said.

The Fargo Veterans Affairs Health Care System launched a foster care program for veterans earlier this year.

The nationwide medical foster home program for veterans has been around since 1998, said Loni Larson, who oversees the program for the Fargo VA.

It’s a partnership that combines VA medical care with a home environment for veterans of any age.

“It’s a win-win for veterans who would otherwise need nursing home care to move in with a family and receive that individual care,” Larson said. “It also gives people in the community a chance to give back to our nation’s heroes.”

So far, three homes have become licensed to care for veterans in the Fargo area, but none has been placed, Larson said.

How it works

Adult foster care is largely funded by federal Medicaid home and community-based care waivers, and some specialty state programs for the elderly, and people with disabilities and chronic illness. Some clients also pay privately for services.

Providers are paid a certain amount for room, board and the level of care required.

Minnesota providers are licensed by the county. David Hallman, who oversees all foster care licenses in Clay County, visits the homes of potential providers before they become licensed.

“We spend many hours with them, trying to get an idea of what type of client or what type of personality they would match best with. We want to get a good fit,” Hallman said.

New clients will spend a few days in the home before their placement is official, to make sure it meets their needs.

Though a prospective provider must obtain a license and pass background checks and home inspection, providers don’t need a background in health care.

Hallman said a wide variety of people decide to become adult foster care providers, from experienced health care professionals and individuals who have cared for a family member to younger people who decide to give it a try.

In Cass County, few people are placed in family adult foster care homes. The licensing process in North Dakota is similar to Minnesota’s, but the program requires service 24 hours a day. In Minnesota, the level of care is arranged between the client and the provider.

State, county and agency officials said adult foster care is a good option because of the individual care provided, and it gives people with disabilities more independence while ensuring safety.

Steven Brewer said he likes his new home with Otoo more than the group home he lived in previously.

“I like it a lot better than corporate foster care. It’s a lot more personable,” he said.

There are advantages such as eating meals together every night and his pet, Kitty.

His wife, Kathleen, agreed, adding that it is easier to work out problems right away.

The caregivers

Gayle and Stan Grafsgaard have been licensed adult foster care providers in Clay County for five years.

The Grafsgaards raised six children who were all starting to leave the nest, so they looked to fill their empty bedrooms by providing care in their home.

“Thought it would be a really good plan for us to do,” said Gayle Grafsgaard. “We did care for my dad in our home, too, for three years before he passed away.”

Over the years, they have cared for several people, including a civil commitment client and a man with terminal cancer.

Susan Tiedeman, 29, has been living in their care for a year. She previously lived on her own for several years.

“It’s a great place to live,” Tiedeman said.

She said she likes the more family-oriented environment. Tiedeman also has an active life outside the home, from her job three days a week at Cash Wise Foods to her routine Saturday trips to the Moorhead Public Library.

Gayle Grafsgaard said Tiedeman also gets a lot of support in the home from medical providers and social workers.

Adult foster care licensees can also work with outside agencies that provide services.

Otoo, who started providing care for the Brewers in October, partners with Lutheran Social Services of Minnesota’s Host Homes program.

Before moving to Minnesota, Otoo said, he had provided adult foster care through the Host Homes program in Colorado since 2008.

He’s licensed through the county but receives additional support from Lutheran Social Services.

Laura Vogel, Host Homes coordinator for the area, said LSS provides training, support and oversight. She helps make the initial matches and meets weekly or twice a week with the Brewers. Vogel said she and LSS are also a resource for providers.

“They don’t think they would do it without the support piece,” Vogel said.

As a new U.S. citizen, Otoo said he enjoys living with real Americans.

“I wanted to take care of someone else who might not be in a position to advocate for himself,” Otoo said.